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Document / 3 pages

IAQ Referral Form, Old WTC Site, Feb 2002

Machine-extracted title · confidence 90%

Form documenting referrals regarding indoor air quality and health conditions at the Old World Trade Center site.

NYC-WTC_000147830–000147832

Folder label: “IAQ REFERRALS TO EPA

Page image
Scanned page image, NYC-WTC_000147832
OCR text

OCR status: ok · source: pdftotext

NYC 9/11 Public Portal Document

Time: | > (1^ rw,.- Name of Operator

Category; (circle one) Cleaning Health Indoor Ail Environment OldWTC Other Specific Contaminant School

Onesfion:

Answer:

I CjYt'LUJt. ~ id Comments: I

roller Infouc ** PH i__ Last Name: Pll First Name: ... Pll I - __ Apt_! Address I: Borough; Address 2:_____ _ —---------- Zip; City Pll Phone #1 C____ _____________ Phone #2 (____ )

Follow op; Refqrral/Follow-Up Needed? (circle one) YES NO

Referral Agency/Organization-.

DEP Reference #

NYC-WTC_000147832

OCR can misread numbers and units. Confirm readings against the page image before using them.

NYC-WTC_000147832Source: NYC Law Department, mirrored locally

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